Dr. Kristine Campbell is a general pediatrician with a clinical focus in child abuse and research training in outcomes and effectiveness. She has designed this career development award to support her short-term career goal of gaining expertise in the longitudinal assessment of children and families with a history of abuse and understanding the multi-dimensional effects of our current interventions on these families. Completion of this award will support her long-term goal of becoming an independent clinician-scientist dedicated research that will improve outcomes among children and families with a history of child abuse or neglect. Dr. Campbell's short and long-term career goals are consistent with the NICHD mission to understand and improve the lifelong health of children and their families. Under the mentorship of Drs. Michael Dean and Heather Keenan, Dr. Campbell has developed a multidisciplinary advisory team and didactic program to provide training in quantitative and qualitative research methods, social and economic policy evaluation, and research ethics related to child abuse pediatrics. This training plan is linked to 3 independent but interrelated research projects, providing a multi-faceted perspective on the experiences of children and caregivers living together after a first finding of child abuse or neglect by Child Protective Services (CPS). In Specific Aim 1, Dr. Campbell will examine the association between longitudinal change in household characteristics (social support, financial resources, and home environment) and repeat referrals to CPS and child well-being over the 36 months following a first-time finding of child abuse or neglect using the National Survey of Child and Adolescent Well-Being. In Specific Aim 2, Dr. Campbell will compare the short and long-term healthcare utilization of children with and without a CPS finding of child abuse or neglect through linkage of Utah CPS and Medicaid databases. In Specific Aim 3, Dr. Campbell will explore the anticipated and unanticipated consequences of CPS involvement in households after a first-time finding of child abuse or neglect through a series of semi-structured qualitative interviews. Findings from these studies will expand our understanding of the 80% of children who remain with their families after abuse, and will inform future research to reduce recidivism and improve outcomes for children and families living with a history of child abuse or neglect. The multi-disciplinary training supported through this research will strengthen the candidate's ability to provide future local and national leadership in design and evaluation of interventions for children and families after abuse. PUBLIC HEALTH RELEVANCE: In the United States, a first finding of child abuse offers a legally mandated opportunity to provide interventions to families at high risk for recurrent violence and abuse. In many cases, however, our response to child abuse fails to resolve the household conditions that contribute to lifelong physical, emotional, and social sequelae of childhood abuse. This award will improve our understanding of the experiences of children and caregivers with a history of abuse and build an evidence base for effective interventions for these families.